剖宫产瘢痕妊娠42例临床分析

Clinical Analysis of 42 Cases of Cesarean Scar Pregnancy

目的探讨剖宫产瘢痕妊娠(cesarean scar pregnancy,CSP)的病因、临床特征、早期诊断及治疗方法。方法对我院2008年1月～2011年12月收治的42例CSP患者的临床资料进行回顾性分析。结果 CSP占同期异位妊娠的1.81%(42/2 316),所有患者术前行彩色多普勒超声检查,明确诊断33例(78.57%)。42例患者中30例行宫腔镜指引下清宫术,6例行药物治疗+清宫术,3例行双侧子宫动脉栓塞术联合化疗+清宫术,2例行经腹妊娠病灶切除术+子宫瘢痕修补术,1例引产排胎过程中出现DIC切除子宫。结论 CSP近年来呈上升趋势,彩色多普勒超声图像具有特征性,是诊断CSP最为直接、准确、简便的手段。宫腔镜指引下清宫术能明确孕囊着床部位,彻底清除妊娠病灶,减少手术时间及术中出血,避免子宫破裂,是安全有效的治疗方法,可作为CSP治疗的备选方案之一。

Objective To discuss the etiological factor,clinical characteristics,early diagnosis and treatment methods of cesarean scar pregnancy（CSP）.Method 42 cases of CSP in our hospital between January 2008 and December 2011 were retrospectively analyzed.Results The CSP cases accounted for 1.81%（42/2 316） in ectopic pregnancies.All patients received color Doppler ultrasonography examinations,and 33 of them were final diagnosed with the diagnosis rate of 78.57%.30 CSP patients received uterine curettage under hysteroscope,6 patients got surgery and medication,3 patients got uterine artery embolization therapy,2 patients got abdominal operation and 1 patient got hysterectomy.Conclusions There is an increasing tendency of CSP in recent years.Color Doppler can give guidance to the early diagnosis,treatment and following-up of CSP because of the sonographic specificity of CSP.Uterine curettage under hysteroscope is safe and effective for CSP,with the advantage of minimal invasion,shorter duration of the operation,less blood loss and quick recovery.